A vision for transformed care

Creating the five year forward view for social care

Health and care systems are under unique pressure from falling budgets and rising demand.

Incremental change is not an option. Now is the time to re-build adult community care and health systems from the bottom up. We need to re-shape service interventions – not only around a more individual understanding of people’s needs, but also around the creativity and capacity of individuals and families and leadership within communities. Too often in the past, the potential of people and communities to contribute to better services has been overlooked.

Total transformation must change systems and processes, but first it must change hearts and minds. We need language that we all understand – that enables managers to explore ways to improve services whilst balancing budgets, but also helps people to think about how their communities can flourish. It will be difficult – trust me – but we need to find goals that we can all agree are worth working towards.

Building a ‘good life’

Our vision is for every area to have the difficult, honest and creative local conversations which release ‘stuck’ systems and create space for moving forward together.

These conversations start not with questions about services and budgets, but with

What does a good life look like in this area and what are we all willing to do to achieve it?

This question can lead on to considering the five key ways in which health and care systems try to help older and disabled people build a good life, and the most promising local and national models for transformational change in each.:

Helping people and families to stay well, connected to others, and resilient when facing health or care needs.

Supporting people and families who need help to carry on living at home.

Enabling people with support needs to do enjoyable and meaningful things during the day, or look for work.

Developing new models of care for adults and older people who need support and a home in their community.

Equipping people to regain independence following hospital or other forms of health care.

Evidenced and promising models

Models which are currently peripheral in each of these five areas must become the centre of the new system.

We have identified six well-evidenced models, which demonstrate how to combine scarce state resources with the capacity of individuals, families and communities. Local areas can use these models to consider the impact they may have in their own area. They can also enable frontline workers to shape more fulfilling roles and draw more effectively on the voluntary, community and social enterprise sector.

Every local area needs to build its own solutions,but there are also many transferable features which the most promising models have in common. Some models are already wellevidenced and nationally available, like Shared Lives and Age UK’s Living Well service (below).

For promising models which are not yet widely researched, we have produced a logic modelling template (See Developing logic models for promising models). Local areas can use this template to consider the potential risks of incremental investment based on emerging evidence. This is not a model for time-limited pilots, but for investments which start small and plan to scale up what works, transferring resources from less cost-effective services.

Re-imagining health and care

If we can work with a number of local areas to re-imagine social care and develop costed models which feel like a better and more sustainable system, we have the opportunity to build a national case for investment. This could be the missing piece in the Five Year Forward View for the NHS and a significant step towards integration which works for and with people, families and communities, combining their capacity with the resources, expertise and backup of health and care services. This draws on the first three of five principles outlined by the Realising the Value partnership:

Implement person- and community-centred ways of working across the system, using the best available tools and evidence.

Develop a simplified outcomes framework, focused on what matters to people.